Frequently Asked Questions: Home Health Care vs. Home Care in Indiana
Although Home Health Care and Home Care are both delivered in the home, they serve different purposes.
Home Health Care = Medical/Clinical Need. It provides skilled or health-related services under an established Plan of Care. For Indiana Medicaid, home health services must be medically necessary, ordered in writing by a qualified attending practitioner, and generally provided part-time or intermittently
Home Care = Personal/Supportive Need. It primarily helps with personal care, supervision, companionship, homemaking, and everyday activities. Indiana Medicaid regulations specifically distinguish health-related home health nursing from homemaker, chore, and sitter/companion services.
1. What is Home Health Care?
Home Health Care provides healthcare services in the patient’s residence for an illness, injury, disability, recovery, or other qualifying health condition.
Home Care generally provides non-medical assistance that helps a person safely complete everyday activities and remain independent at home Services may include skilled nursing, physical therapy, occupational therapy, speech-language pathology, and home health aide services when applicable. Indiana Medicaid requires covered home health services to be medically necessary and provided according to a written Plan of Care.
Home Care generally provides non-medical assistance that helps a person safely complete everyday activities and remain independent at home Services may include skilled nursing, physical therapy, occupational therapy, speech-language pathology, and home health aide services when applicable. Indiana Medicaid requires covered home health services to be medically necessary and provided according to a written Plan of Care.
2. What is Home Care?
Home Care generally provides non-medical assistance that helps a person safely complete everyday activities and remain independent at home.
Services may include bathing, dressing, grooming, toileting, mobility assistance, meal preparation, light housekeeping, laundry, companionship, and safety supervision.
Services may include bathing, dressing, grooming, toileting, mobility assistance, meal preparation, light housekeeping, laundry, companionship, and safety supervision.
3. What is the biggest difference?
The primary distinction is the reason for the service:
Home Health Care: A medical, nursing, rehabilitative, or other qualifying health-related need.
Home Care: Assistance with personal care, supervision, household activities, companionship, and everyday living.
Home Health Care: A medical, nursing, rehabilitative, or other qualifying health-related need.
Home Care: Assistance with personal care, supervision, household activities, companionship, and everyday living.
4. Does Home Health Care require medical necessity?
Yes, when required by the applicable payer or program.
For Indiana Medicaid home health, medical necessity is a core coverage requirement. The documentation must establish why the requested home health service is medically appropriate and necessary.
Simply wanting additional help at home does not, by itself, establish medical necessity for Home Health Care.
For Indiana Medicaid home health, medical necessity is a core coverage requirement. The documentation must establish why the requested home health service is medically appropriate and necessary.
Simply wanting additional help at home does not, by itself, establish medical necessity for Home Health Care.
5. What does “medically necessary” mean?
Indiana Medicaid describes medical necessity as determining whether healthcare services are medically appropriate and necessary to meet basic health needs, consistent with the patient’s diagnosis or condition, cost effective, and consistent with recognized medical-practice guidelines regarding the type, frequency, and duration of treatment.
Documentation should therefore connect:
Diagnosis → Clinical or Functional Deficit → Required Service → Frequency/Duration → Expected Benefit
Documentation should therefore connect:
Diagnosis → Clinical or Functional Deficit → Required Service → Frequency/Duration → Expected Benefit
6. Does Home Care require medical necessity?
Not necessarily.
Private-pay non-medical Home Care may be based on the individual’s need for assistance, supervision, safety, or support with daily activities.
Medicaid waiver and other publicly funded programs have separate eligibility, assessment, authorization, and service-plan requirements.
Private-pay non-medical Home Care may be based on the individual’s need for assistance, supervision, safety, or support with daily activities.
Medicaid waiver and other publicly funded programs have separate eligibility, assessment, authorization, and service-plan requirements.
7. Does having a diagnosis automatically qualify someone for Home Health Care?
No.
Having diabetes, CHF, COPD, stroke, dementia, hypertension, or another diagnosis does not automatically establish the medical necessity of a particular home health service.
Documentation should explain how the condition creates the need for the specific service being requested.
Having diabetes, CHF, COPD, stroke, dementia, hypertension, or another diagnosis does not automatically establish the medical necessity of a particular home health service.
Documentation should explain how the condition creates the need for the specific service being requested.
8. Who orders Home Health Care?
Indiana Medicaid requires home health services to be ordered in writing by a qualified attending practitioner and provided under a written Plan of Care.
This clinical oversight is an important distinction from ordinary non-medical Home Care.
This clinical oversight is an important distinction from ordinary non-medical Home Care.
9. Does Home Care require a physician’s order?
Routine private-pay non-medical Home Care generally does not require a physician’s order simply for companionship or assistance with everyday activities.
Requirements may differ for Medicaid, HCBS waiver, long-term-care, or other funded programs.
Requirements may differ for Medicaid, HCBS waiver, long-term-care, or other funded programs.
10. Who provides Home Health Care?
Depending on the patient’s needs and Plan of Care, services may involve:
- Registered Nurses (RNs)
- Licensed Practical Nurses (LPNs)
- Physical Therapists
- Occupational Therapists
- Speech-Language Pathologists
- Home Health Aides
- Other qualified healthcare professionals when applicable
11. Who provides Home Care?
Non-medical Home Care may be provided by caregivers, personal care attendants, direct care workers, homemakers, companions, or other appropriately qualified personnel.
Their primary role is supporting activities of daily living, safety, supervision, and independent living rather than independently providing skilled nursing services.
Their primary role is supporting activities of daily living, safety, supervision, and independent living rather than independently providing skilled nursing services.
12. Can a Home Health Aide provide skilled nursing care?
No. A Home Health Aide is not a substitute for a licensed nurse.
A Home Health Aide may provide approved personal-care assistance within the aide’s permitted role and Plan of Care.
Services requiring professional nursing assessment, clinical judgment, or nursing intervention must be performed by an appropriately qualified licensed professional.
A Home Health Aide may provide approved personal-care assistance within the aide’s permitted role and Plan of Care.
Services requiring professional nursing assessment, clinical judgment, or nursing intervention must be performed by an appropriately qualified licensed professional.
13. What are examples of skilled Home Health services?
Depending on medical necessity, orders, coverage requirements, and the Plan of Care, services may include:
- Skilled nursing assessments
- Medication management
- Certain medication administration or injections
- Wound assessment and treatment
- Catheter-related nursing care
- Monitoring complex or changing conditions
- Diabetes education
- Cardiopulmonary assessment
- Post-hospital monitoring
- Patient/caregiver clinical education
- Physical, occupational, or speech therapy
14. What are examples of Home Care services?
Home Care may include personal hygiene, bathing, dressing, grooming, toileting, meals, light housekeeping, laundry, companionship, safety supervision, mobility assistance, and assistance with everyday routines.
The focus is supporting daily living rather than treating a medical condition.
The focus is supporting daily living rather than treating a medical condition.
15. Can someone receive both Home Health Care and Home Care?
Yes, when eligible and the services address separate authorized needs.
For example, a person recovering from a stroke may require skilled nursing or therapy while also needing attendant assistance with daily personal-care activities.
Services should be coordinated and should not improperly duplicate services paid for by another program.
For example, a person recovering from a stroke may require skilled nursing or therapy while also needing attendant assistance with daily personal-care activities.
Services should be coordinated and should not improperly duplicate services paid for by another program.
16. Does Medicare pay for Home Health Care?
Medicare may cover qualifying Home Health Care. The patient generally must be under the care of an authorized practitioner, need qualifying intermittent skilled services, receive care under an established Plan of Care, and satisfy Medicare’s homebound requirements.
Medicare does not generally cover custodial personal care when that is the only care the person needs.
Medicare does not generally cover custodial personal care when that is the only care the person needs.
17. Does Indiana Medicaid require Home Health patients to be homebound?
No.
This is an important difference from Medicare. Indiana Medicaid states that Home Health Services cannot be limited to members who are homebound.
A Medicaid member may therefore potentially qualify based on medical necessity and other applicable requirements without satisfying Medicare’s homebound standard.
This is an important difference from Medicare. Indiana Medicaid states that Home Health Services cannot be limited to members who are homebound.
A Medicaid member may therefore potentially qualify based on medical necessity and other applicable requirements without satisfying Medicare’s homebound standard.
18. Does Indiana Medicaid cover Home Health Care?
Yes, for eligible members who meet applicable requirements.
Indiana Medicaid Home Health Services may include skilled nursing, home health aide, and qualifying therapy services. Medical necessity, practitioner orders, Plan of Care requirements, and prior authorization requirements apply.
Managed-care members may also be subject to their Managed Care Entity’s authorization and coverage requirements.
Indiana Medicaid Home Health Services may include skilled nursing, home health aide, and qualifying therapy services. Medical necessity, practitioner orders, Plan of Care requirements, and prior authorization requirements apply.
Managed-care members may also be subject to their Managed Care Entity’s authorization and coverage requirements.
19. What documentation helps establish medical necessity?
Strong documentation should explain why this patient needs this particular service at this frequency and duration.
Supporting documentation may include:
The documentation should answer:
“What medical or clinical condition makes this Home Health service necessary, and why is the requested level of care needed?”
Supporting documentation may include:
- Diagnoses and medical history
- Practitioner evaluation and orders
- Current Plan of Care
- Nursing or therapy assessments
- Functional limitations
- Recent hospitalization information
- Medication concerns
- Wound information
- Safety and fall risks
- Progress notes
- Requested frequency and duration
- Clinical reason the service cannot safely be omitted or reduced
The documentation should answer:
“What medical or clinical condition makes this Home Health service necessary, and why is the requested level of care needed?”
20. How do I know whether I need Home Health Care or Home Care?
Home Health Care may be appropriate when:
An illness, injury, disability, hospitalization, or change in condition creates a medically necessary need for skilled nursing, therapy, health-related aide services, or other qualifying clinical care.
Home Care may be appropriate when:
The primary need is personal care, meals, homemaking, companionship, supervision, mobility assistance, or support with everyday activities rather than skilled medical intervention.
Both may be appropriate when:
The person has separate medical and functional support needs and qualifies for both types of services.
At Haven of Care HomeHealth, we can review the referral and care needs, coordinate with the healthcare provider when appropriate, and help determine whether Home Health Care, supportive Home Care services, or both may be appropriate.
Call Haven of Care HomeHealth at 317-909-0715 to learn more about referrals, eligibility, medical-necessity requirements, and available services.
An illness, injury, disability, hospitalization, or change in condition creates a medically necessary need for skilled nursing, therapy, health-related aide services, or other qualifying clinical care.
Home Care may be appropriate when:
The primary need is personal care, meals, homemaking, companionship, supervision, mobility assistance, or support with everyday activities rather than skilled medical intervention.
Both may be appropriate when:
The person has separate medical and functional support needs and qualifies for both types of services.
At Haven of Care HomeHealth, we can review the referral and care needs, coordinate with the healthcare provider when appropriate, and help determine whether Home Health Care, supportive Home Care services, or both may be appropriate.
Call Haven of Care HomeHealth at 317-909-0715 to learn more about referrals, eligibility, medical-necessity requirements, and available services.